Hospitals are cornerstones of their communities. Beyond treating injury and illness, hospitals and health care systems advance people's health and well-being and serve as an economic engine in the community. Teams of physicians, nurses, volunteers, patient advocates and other health care professionals not only provide care within the hospital walls, but also improve the overall health of communities.
Hospitals today are intently focusing on redefining the "H" — that is, exploring what it means to be a hospital in a rapidly transforming health care environment. Consumers, policymakers, legislators and businesses all are demanding change in the health care field — at a time when hospital administrators are faced with diminishing resources while hospital teams are caring for an aging population and more patients with multiple chronic conditions. Despite these challenges, technological and medical advances are allowing providers to deliver care that is more complex and more individualized than ever before. This progress will impact how care is delivered and financed and will necessitate that hospitals focus on finding the best community solutions to improve health outcomes.
The 2014 AHA Committee on Research and the 2014 Committee on Performance Improvement jointly released the Leadership Toolkit for Redefining the H: Engaging Trustees and Communities, based on feedback from more than 1,000 C-suite leaders and board chairs about their journeys of transformation.
Achieving the Triple Aim
Guided by the Institute for Healthcare Improvement's Triple Aim, hospitals and health care systems are looking at different paths and approaches to redefine themselves and to further develop strategies and business models for sustainability. (The 2013 AHA Committee on Research outlined five paths — specialize, partner, redefine, experiment and integrate — in its report "Your Hospital's Path to the Second Curve: Integration and Transformation.") To improve the overall health of patients and communities, hospitals throughout the country are:
- improving the experience of care for patients, involving patients and families in care teams, helping to coordinate services among providers, and helping patients navigate the health system;
- moving toward proactive population health with a strong focus on prevention and wellness strategies, keeping patients safer and out of the hospital;
- working to reduce non-value-added care and identifying opportunities to increase efficiency, improve quality and reduce the overall cost of care.
Engaging Communities in Redefining the H
Far from being insulated to the challenges and opportunities associated with change and transformation, hospitals and health care systems should consider new ways to engage with communities and assess how changes in the health care delivery system will affect patients and consumers. Hospitals should be redefined in a manner that positively impacts the overall health of a community and is supported by the community.
The AHA believes that changes as significant as those likely to occur in the coming decade need to be planned for, not only within the hospitals, but also with strong input and engagement from the local community. In 2014, the AHA Committee on Research and the Committee on Performance Improvement focused on how hospitals can engage with community stakeholders to discuss the changing health care landscape. The committees also examined how hospitals can educate and engage leaders at the governance level — those who can help to navigate new payment models, delivery system reforms and community health challenges.
The Leadership Toolkit includes a report plus several tools and resources that address community engagement and governance strategies for hospital leaders.
Common Themes from Community Conversations
As part of its work, the 2014 AHA Committee on Performance Improvement hosted several "community conversations" across the United States, listening and learning from community partners and seeking to foster further community collaboration and engagement. These events brought together a diverse group of community and health care stakeholders for a moderated discussion of current health challenges, implications of transformation, and a shared future and vision for the hospital's role in community health.
The community conversations revealed common themes from stakeholders as well as shared recommendations for hospital and health care system leaders and boards working to solve the bigger challenges of changing the health care environment. Recommendations include:
- Engage in broad-based dialogue. In particular, move outside your hospital's comfort zone to listen to voices and perspectives that often go unheard in general hospital meetings and planning sessions. Community conversations, for example, are opportunities for education and for listening, learning and strengthening vital community relations.
- Join with community partners to ensure that national health policy changes incentivize public-private partnerships and help consumers become more integrated in the health care system and more active in their health care.
- Convene ongoing forums and community conversations for stakeholders to discuss and understand the changing health care environment. These conversations will offer important insights for hospitals during transformation.
- Conduct a community health needs assessment to facilitate transformation, collaboration and allocation of community resources. Data must be objective and allow all stakeholders to agree to priority health goals. The CHNA should be an interactive, collective process that helps multiple stakeholders lay a foundation and infrastructure to "do more" together.
- Approach health care holistically. Prevention needs to be front and center, as it will take more than just hospitals and health care systems to effect change. The focus should be on the determinants of health, not just health care or hospital care.
All health care is local, and transformation is likely to play out differently in different communities. That is why, regardless of the work the AHA is doing to gain some national perspective, it is important for hospitals to convene community stakeholders to listen, learn and gain an understanding of how changes in the health care field will affect the community. Doing so will put hospitals and communities in the best position possible as the role of the hospital changes and population health emerges as a framework for achieving the Triple Aim. All community partners, including multiple or "competing" hospitals, must find ways to collaborate and work together, breaking down barriers for change and sharing goals for improved health status.
Two sections in the Leadership Toolkit outline a step-by-step process for conducting community conversations, complete with a moderator's guide, slide deck and questions.
Redefining the H also will require rethinking governance structures — putting new structures in place to effectively manage increasingly complex organizations with their multiple clinical and operational units and functions. Hospitals and health care systems will need to better equip their trustees with new skills and tools as well as empower them to make hard decisions in the face of uncertainty. The Leadership Toolkit includes several sections with valuable information: "High-Performance Governance Practices," "Competency-based Board Compositions" and "Creating the Right Boardroom Conversations."
Putting It All Together
In the rapidly evolving health care field, hospitals are going to be asked to do "more" for patients to keep them healthy and out of the hospital, to provide better coordinated care, and to demonstrate greater integration among providers and care settings — all with fewer resources. A redefined hospital and health care system can be achieved only through mutual trust and transparent, two-way collaboration among C-suite leaders, boards of trustees, multidisciplinary teams and a diverse group of community stakeholders.
Find more information, survey results, recommendations and resources in the Leadership Toolkit for Redefining the H: Engaging Trustees and Communities and visit the AHA website.
Jonathan B. Perlin, M.D., chair of the AHA board and the 2014 AHA Committee on Research, is chief medical officer and president of clinical services at HCA in Nashville, Tenn. Thomas W. Burke, M.D., chair of the 2014 AHA Committee on Performance Improvement, is the executive vice president of Cancer Network at the University of Texas MD Anderson Cancer Center in Houston.